For too many Americans, medical care is becoming increasingly difficult to access. A shortage of health care providers and rising costs of services prevent many people from getting even basic medical care, let alone being seen by a specialist.
To tackle this problem, two rheumatologists in the University of Colorado Anschutz Department of Medicine have spent the past year exploring innovative ways to help more patients with autoimmune and inflammatory conditions get the care they need.
Associate Professor Mila Kastsianok, MD, and Assistant Professor Steven Taylor, MD, both in the Department of Medicine, have collaborated on hiring new rheumatologists, increasing clinical availability at off-campus locations, and rolling out digital-enabled services such as inpatient and outpatient eConsults that can help doctors reach more patients.
“Access to medical care is an issue all over the U.S., and it’s not going to get better over time,” says Kastsianok. “How can we as doctors work creatively together to ensure that the needs of patients are met?”
Many people are living with unmet health care needs. Recent polling suggests that in the past year alone, more than one-third (36%) of U.S. adults have skipped or delayed getting needed care because of costs. And by 2038, the Bureau of Health Workforce estimates the U.S. could face a shortage of more than 70,000 primary care physicians.
When people skip or delay care, or when they simply can’t get a timely appointment because there are too few care providers, the consequences can be severe. Diseases can advance, leading to complications and the need for even more treatment. People can experience chronic pain and suffering, have a diminished quality of life, and even die prematurely due to a lack of care.
There’s a shortage of health care providers across all areas of medicine, but rheumatologists are in especially short supply. Already, patients may often wait months to see a rheumatologist. Meanwhile, autoimmune disease diagnoses are increasing by roughly three to 12% per year. Additionally, relatively few medical students today are choosing to become rheumatologists, and many of the existing doctors in the field are approaching retirement age.
“There is an imbalance between patients needing to be seen and not enough rheumatologists to accommodate the demand,” says Kastsianok.
Taylor says rheumatologic diseases can be devastating, impacting multiple body systems and potentially touching every area of a patient’s life.
“In recent years, we have made tremendous strides in discovering and translating remarkable therapies that truly change lives, but that only helps the patients who can be seen,” he says.
Kastsianok and Taylor have worked together at the UCHealth Rheumatology Clinic at CU Anschutz since early 2024 — Kastsianok as a medical director for rheumatology and Taylor as a community practice director. The two wanted to hire more rheumatologists at their clinic, but because of limited space, they had to explore other options.
“We worked really hard to expand the footprint of rheumatology to off-campus UCHealth clinics,” Kastsianok says. “So, we tried to find space in other clinics to hire rheumatologists.”
Kastsianok and Taylor were able to expand rheumatology services at the University of Colorado Hospital satellite clinic in Lone Tree and a UCHealth clinic in Cherry Creek. The Lone Tree location, which previously offered very limited rheumatology services, now has the equivalent of one full-time rheumatologist on-staff to serve patients in southern Colorado, an area of the state where rheumatologists are scarce. The Cherry Creek clinic offers centralized access to patients across the Denver metro area.
Taylor, who was born in rural Colorado, emphasizes the impact of expanding service in underserved parts of the state.
“Rural communities often have profound issues with access to care. Many times patients have to drive five to six hours just to see a specialist,” he says. “If we can work on creative applications of existing technologies to serve the residents of Colorado better, I’m all ears.”
In addition to hiring more doctors in key locations, Kastsianok and Taylor have explored ways to provide rheumatology care and expertise that go beyond traditional, in-person clinic visits or even telehealth appointments.
For many patients, especially those who are very ill and need treatment right away, clinic visits are still the gold standard. Other patients may experience some symptoms of a rheumatological illness but aren’t as acutely sick, and they may not need to see a rheumatologist immediately, even if their primary care provider has referred them to one.
For these patients, Kastsianok and Taylor are developing a novel application of eConsults that would allow rheumatologists to connect with referring primary care providers and offer specialized expertise without seeing a patient face-to-face.
CU Anschutz’s eConsult program has been active since 2018 and is run by The Care Collaborative in partnership with the AAMC Project CORE. Taylor is the eConsult clinical informaticist and specialty transformation lead for The Care Collaborative.
After asking some questions, Kastsianok says, “We can provide some advice or guidance to the referring provider on what to watch for, what to do, what lab tests or imaging to order, to further evaluate the patient.”
Based on the consultation, doctors can triage each patient and decide whether they need more specialized care or whether they can remain in their patient-centered medical home, keeping care local and with clinicians the patients know and trust.
These consultations could potentially allow many more patients to get specialized rheumatological advice and care without the hassle of an appointment. They can also save time — currently, the average wait time for a rheumatology appointment is around 30 days, but the time to receive an answer via an eConsult is less than 48 hours.
Additionally, Kastsianok and Taylor are involved in a pilot effort to give inpatient eConsults to patients at UCHealth partner hospitals. While some patients may need to transfer to another hospital or facility for specialized rheumatologic care, others could use the new eConsult process to receive advice from a specialist without needing to transfer somewhere else.
This work, led by the Virtual Health Center at UCHealth, could reduce the need for patients to transfer hospitals and help provide rheumatology care to underserved areas of the state.
Today, only three hospitals in Colorado — the UCHealth University of Colorado Hospital, the Denver Health Medical Center and Hospital, and the Rocky Mountain Regional VA Medical Center — offer inpatient rheumatology care. Many of these inpatient eConsults are done for patients in Pueblo or Colorado Springs, and transferring to a Denver area hospital would potentially mean being hours away from home.
Reducing unnecessary hospital transfers can also be safer for many patients. It minimizes the potential for disruptions and delays to the patient’s care, and avoids the potential complications of transferring medical records and transitioning to a new care team.
Because the inpatient and expanded outpatient eConsult programs are so new, it’s too soon to definitively quantify their impact. But there are already promising signs that doctors at the UCHealth Rheumatology Clinic are reaching more patients.
The clinic’s access metric — the number of appointments scheduled within 14 days — has grown by 9.4% compared to last year, and the median lag time — or the time between scheduling an appointment and seeing a rheumatologist — has decreased by 19 days.
Going forward, Taylor says he wants to continue building on these successes and examining the issue of patient access from a systemwide perspective. But Kastsianok and Taylor both express pride in the work that’s already been done to improve patient access and broaden the reach of rheumatology care across Colorado.
“It’s truly rewarding to find a challenge, face it, and work with other teams to solve this access issue,” Kastsianok says. “We have to be as creative as possible with limited resources to ensure that patients get access to care and can at least get some kind of guidance from a specialist.”